dear sir,

what is the indication to do the serum toxoplasmosis in this patient? how we do that?

i have problem in making diagnosis for a simple CNS case... i just duno where to start n how to start.. is there any guideline or way to make diagnosis from symptoms? take this patient as example, the most diagnosis i can make is right sided hemiparesis ... etiologically.. anatomically.. i really dont know how to reach to a complete diagnosis... or maybe sir can give other clinical scenario to explain how to reach to a diagnosis...

thank you sir.

-24 chinese female, no known medical condition...
-duration : 3 days. Previously had one similar episode but cant recall much...
-bro has skin problem too... since 2-3 years,bro had excessive wheal n flare response... when ever bro scrach or wipe the
 body, it will become reddish.. even can write on the skin...
-no history of allergy, no history of allergen exposure or food allergy or any specific thing that can relate to the skin rash..
-no other symptoms of musculo cutaneous inolvement...joint pain, skin nodules, conjunctival involement.

-sorry sir, no photo..

-maybe should advice that next time when similar episode occur,go get a patch test done?

scenario :

-Recurrent episodes of maculo-papular rashes... it lasted for one-two days then disappeared .. then it appear again few   
 days after that...
-Involved both upper and lower limbs, especially near elbow (medial epicondyle), arms, n popliteal fossa..then the back...
-Associated with itchiness on and off, and the rashes tends to increase with scratching...
-it was noticed that it happens whenever its cold or in ac room...
-no other signs of allergy..

what can this be? 

hi sir.. thanku sir for the clarification...

now i'll remember.. UPPER face spared in UPPER motor neuron type palsy... so any UMN lesion,the upper face is spared along with UMN features in motor system like hyper reflexia, hypertonia, babinski +ve, absent superficial reflexes..

sir, is this drug available in malaysia? howbout the cost?

hi sir,


that's the msg sir put... but wat did sir meant by lesion in LEFT BRAINSTEM with an example at the level of RIGHT PONS? why the sides are different?

and.. when we use contralateral or ipsilateral... wat we meant? the site of lesion with the manifestation in the body.. or the manifestation in the different part of body?

and.. where does the facial nerve fibers decussate?

and.. when we say right UMN facial palsy... we referring to the side of lesion or the side of manifestation?? means the lesion occurs at right side causing left lower face afftected.. or there is right sided lower face involvement caused by a left sided lesion?

whenever i have a facial palsy case,i'll need to think the whole pathway to confirm that its UMN or LMN...because i dun wan to memorise that in UMN we'll have lower face involvement.. or in LMN we'll have whole half involvement... is there any easier way... or i have to memorise like that.. or i'll automatically know which side if i prac more?

thanku sir..

thanku sir...

but still having doubts....

1.benzathine penicillin given in RF is to eradicate Gr A beta hemolytic Strep, not really S.pneumoniae, 
   because A beta hemolytic strep are the cause of RF. rigth?

2.but based on the reply on 28th may, sir said that, prevention of S.pneumoniae infection>>prevents   
   subsequent RF>>prevents RHD... here sir used S.pneumoniae, why?

3. can we say that,we are preventing S.pneumoniae (which is commoon in URTI) to prevent RF because   
    RF is immunological mediated... so S.pneumoniae infection will cause antigenic eff same as A beta
    hemolytic Strep, and cause RF?

4. patient with RF need prophylaxis for RF.. but if they develop RHD,do we stil cont with this prophylaxis
    regimen, or we switch it to prophy for IE which can aff the valve in RHD, or we use both regimen?

thanku sir for the details...

helo sir, thanku for the reply.. but sir purposely pointed out that it is beta-hemolytic strep.. n not S.pneumoniae that is involved here.....

does this mean that the benzathine penicillin given in RHD is for beta-hemolytic strep n not S.pneuminiae... or

resistance is usually seen in beta-hemolytic strep n not S.pneumoniae?? so by giving penicillin in RHD, we are preventing S.pneumoniae but may also cause resistance to develop in beta-hemolytic strep?

thanku sir..

just read this discussion n a doubt just pop in... in RHD we give long term benzathine penicillin to prevent S.pneumoniae infection, preferably life long.... but will this cause drug resistance?

thanku..

In auscultation of RS, is it possible that the findings differ before and after taking nebulization?
eg: before nebulization, generalized rhonchi were heard. But after 2 hours, when i went back to check, there is no generalized wheeze.. instead of this, theere are coarse crepitations over few areas... and the breath sound seems to be bronchial breath sound...

thank u.